Neurology & Pain Management Coding Alert

Question: Our practice recently purchased VNG testing equipment to assess patient balance issues. We have some questions regarding code 92546. Our state does not have an LCD for this code, but we have some information from the company regarding the LCD in Florida. We have not purchased a rotational chair but the Florida LCD states that active head rotation is sufficient when no rotational char is available. Is this correct? How do you recommend we approach coding? 

West Virginia Subscriber

Answer: Medicare’s Medically Unlikely Units (MUE) limit for rotary chair services (92546, Sinusoidal vertical axis rotational testing) is one unit. Additionally, the American Medical Association (AMA) agrees that 92546 should reported only once per encounter, and would not reported per eye or per axis rotation (according to the May 2011 CPT® Assistant). If you filed a claim with Medicare and the third-party insurer pays you for only one unit, you cannot balance-bill the patient if your contract prohibits it.

Good news: Many insurers follow Medicare’s lead, so you can always tell a reluctant payer that Medicare does cover 92546.

While code 92546 originally was intended for computerized rotational chair testing, some practitioners also use it for active head rotation (AHR) testing. It is not clear whether this practice is allowed, although the AMA does not feel that AHR testing justifies a separate code (see the June 2013 CPT® Assistant). 

Test explanation: The procedure represented by 92546 (formerly known as the sinusoidal harmonic acceleration test) measures various parameters of normal and pathological vestibular systems. This test also estimates the patient’s visual acuity by checking the visual–vestibular interaction.